Piriformis Syndrome: The Best 6 Exercises To Help Your Hip & Butt Pain

By Dr Ken Nakamura+

Piriformis Syndrome Can Give You Buttock Pain: Toronto Downtown Chiropractic

Do you have a pain in the butt that gets worse with sitting?


Does your buttock pain turn into sciatica or leg pain occasionally?


Have you been diagnosed with a disc herniation or piriformis syndrome?


In this article I show you the difference between herniated discs and piriformis syndrome then at the end show you the 6 exercises for piriformis syndrome.


 Piriformis muscle is deep inside your buttock which gets very tight and irritated when there is pressure on it, like when you are sitting. Your piriformis muscle ‘s job is to rotate your hip outward away from the body so you can shift your weight from one foot to another. The problem is it often get mixed up with herniated discs.


Both herniatied discs and piriformis syndrome can cause buttock pain and sciatica. It’s so easy to mix up that many doctors and chiropractors mix the two very similar diagnosis up. Most of them will diagnose a disc herniation, sacroiliac syndrome, and facet syndrome but rarely piriformis syndrome.


The problem is the treatment for disc herniation is different from piriformis syndrome treatment.


See Also: Your Guide To Disc Herniations & Disc Bulges

See Also: Best Self-Treatment For Your Disc Herniation


Piriformis Syndrome is not that rare. Today I will show you a couple tests that you can do yourself so that you can keep your chiropractor or medical doctor on the ball when they are diagnosing you.


Picture of sciatic nerve and piriformis muscle


Piriformis Syndrome Can Give You Buttock Pain: Toronto Downtown Chiropractic

Most of you (96%) have your sciatic nerve come out underneath the piriformis muscle as shown in the picture above. [1]  You can see the sciatic nerve but you can’t see that it is actually formed by 5 nerves that join together. The picture below shows nerves from the lower back and pelvis joining together to form the the sciatic nerve.

Sacrum and sacral nerves that form sciatic nerve


For the unlucky few though the sciatic nerve passes right through the piriformis muscle. This makes your piriformis muscle more vulnerable to pain. The piriformis muscle often gets tight naturally from sitting too much. We weren’t really designed to sit for so long and put so much pressure, on this muscle. When the muscle gets tight the nerve get irritated and causes a vicious circle of pain.


Tight Piriformis ->> Nerve Irritation->>Tighter piriformis ->> More Nerve Irritation


This vicious circle whatever the cause will likely make you feel pain in the buttock especially the hip area (2nd picture above) and right near the sacrum  (2nd picture above). You might even have difficulty walking.[2]


Tests For Piriformis Syndrome


The first key test to look for with piriformis syndrome is when you sit down. Lift your bad side foot onto the seat of the chair then bring your bad leg toward the opposite chest. You might feel some pain if you have another problem like a disc bulge. With piriformis syndrome this maneuver will give your buttock agonizing pain, or at least a lot more pain. [3-4] You might have pain in the hip area or right in the middle of the buttock or more toward the center of the pelvis, and even sciatica. This sign along with a number of other positive signs increases the likelihood that you have piriformis syndrome.

 See Also: MRI, CAT Scans & X-rays Your Guide


This minor test although not a key sign is, if you push on your own buttock and feel pain in the above areas it maybe a sign that you have piriformis syndrome. It is easier to lie down on your back with a tennis ball underneath your buttock.


The second key test is when you lie down on your back. Both of your feet should point upwards. If you find that on the side of your painful butt, your toes are going outward more you have a tight piriformis muscle. The piriformis’ job is to turn your hip out. When it’s really tight your foot will be forced to turn out. The real key is when you try to bring your toes back toward the center you will be faced with some pain. This further increases the chance that you have piriformis syndrome.[5-6]


The second minor test. Your tight piriformis can cause the sacrum to rotate and cause a short leg on the tight piriformis side.[7-8] Do you have a short leg on the side of your painful piriformis? This is a difficult one to tell but you can try by sitting on the floor with your legs straight out in front of you. Try to have your body straight and your arms in the exact same spot. Even your head should be looking straight ahead.


In the picture below you can see that the left foot is short.

Leg length difference: Piriformis Syndrome Can Affect Your Leg Length: Toronto Downtown Chriorpactic



X-rays and MRI For Piriformis Syndrome

X-rays and MRI won’t tell you if you have piriformis syndrome. They usually do more to persuade medical doctors and chiropractors that you have something other than piriformis syndrome. In other words X-rays and MRI can often mislead your health practitioner.


After finding a lot of the above tests that we talked about positive your chiropractor should have piriformis syndrome as one of the number of  possible diagnosis. Your chiropractor will do other tests to determine if the piriformis muscle is involved. Then they take an X-ray or MRI or a CAT Scan. That’s when things go wrong.


Most of you that are 40 years of age an older have degenerative disc disease. It might be mild or moderate. The report says degenerative disc disease, disc herniation or even osteoarthritis. The problem is these problems that are visible on X-ray don’t necessarily cause any pain.


See also: Degenerative Disc Disease: Remedies For Lower Back Osteoarthritis


See Also: Part 2 Exercises – Degenerative Disc Disease: Best Exercises To Help Your Lower Back Pain




Your X-ray report says you have moderate degenerative disc disease and you have sciatica that matches the  pinched nerve from degenerative disc disease. The X-rays have found your diagnosis right? Pictures of degenerative disc disease in some cases influence your medical doctor or chiropractor. Some may even disregard your exam finding or more commonly, they don’t do the other tests to begin with, letting the X-rays become the overriding factor instead of confirming a diagnosis that they previously had in their head. Your chiropractor or doctor in that case will miss the diagnosis.


If your chiropractor doesn’t think about a possible diagnosis they can’t do the test.


Keep in mind there are orthopedic tests that your chiropractor will use to help diagnose you. Since you can’t do them yourself I won’t go over those tests here.


Treatment for Piriformis Syndrome


#1 Piriformis Stretch: Seated

Piriformis stretch seated: For Piriformis Syndrome - Toronto Downtown Chiropractor



  1. Sit in a sturdy chair.
  2. Cross your affected leg over your knee, resting your foot on top of your knee.
  3. Keep your back straight, and slowly lean forward until you feel a stretch in your hip.
  4. Hold for 30 seconds.


#2 Piriformis Stretch: Laying Down

Piriformis Stretch Supine: For Piriformis Syndrome - Toronto Downtown Chiropractor

  1. Lay down on your back.
  2. Cross the affected leg over other bent leg.
  3. Pull the unaffected leg towards you until you feel the stretch.
  4. Hold for 30 seconds 3 times.

#3 Stretch Your Hip Stabilizer: Gluteus Medius –  Pigeon Pose

Pigeon Pose Gluteus medius stretch: Toronto Downtown Chiropractic

  1. Start on all fours like a crawl position.
  2. Bring your right leg forward and bent with the other leg straight back.
  3. Reach out forward with your body till you feel it in your hips.

Do this for 30 seconds 3 times.

#4 Bridge Exercises: Strengthen your Gluts

This exercise is for those that are not quite ready for the next two exercises.

Degenerative Disc Disease Exercises Supine Plank: Downtown Toronto Chiropractic


  1.  Get on your back with your knees bent and hands down by your side.
  2. Lift up until your torso is straight like in the picture above.
  3. Go back down and as when you touch the floor, go back up again.

Do this exercise 15 times for 3 sets.

#5 Strengthen Your Hips: Squats


How to Improve Posture-Chair Squats: Toronto Chiropractic Clinic

  1. Stand in front of a chair with your knees shoulder width apart.
  2. Turn your toes out slightly
  3. Go to sit down leading with your buttock until your butt touches the chair.
  4. When your buttock touches the chair get back up again without resting.

Advanced: Don’t use a chair and go to 90 degrees.


# 6 Strengthen Your Hips: Lunges

Lunge Exercise For Piriformis Syndrome - Toronto Downtown Chiropractor


  1. Stand with your legs together and arms at your sides
  2. Step two to three feet (60-90 cm) forward with your left foot.
  3. Bend both of your knees to lower yourself into a lunge.
  4. Each knee should be 90 degrees. Keep your knee directly over your ankle so you don’t strain your knee.
  5. Push off with your left leg and return to the starting position.
  6. Repeat with your other leg.

Do this 10X on each leg. 3 sets should be fine.

If you have trouble doing this you can do a more shallow lunge by not going down as deep.


Tell us what you think in the comments below and like us on Facebook. I will answer all questions in the comments section here at this downtown Toronto Chiropractic clinic.



1. 15. Beason LE, Anson B.J. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Record1937;70:1-5.

2. Lori A. Boyajian-O’Neill, DO et al, Journal of the American Osteopathic  Association, Diagnosis and Management of Piriformis Syndrome: An Osteopathic Approach

3. Chaitow L. Soft Tissue Manipulation: A Practitioner’s Guide to the Diagnosis and Treatment of Soft-Tissue Dysfunction and Reflex Activity. 3rd ed. Rochester, Vt: Healing Arts Press;1988 .

4. Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am1999;81:941-949

5. TePoorten BA. The piriformis muscle. J Am Osteopath Assoc1969;69:150-160.

6. DiGiovanna EL, Schiowitz S, Dowling DJ, eds. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins;2005 .

7. Retzlaff EW, Berry AH, Haight AS, Parente PA, Lichty HA, Turner DM, et al. The piriformis muscle syndrome. J Am Osteopath Assoc1974;73:799-807

8.  Grant JH. Leg length inequality in piriformis syndrome. J Am Osteopath Assoc.1987;87:456 

9. Kevork Hopayian et al., The clinical features of the piriformis syndrome: a systematic review. Eur Spine J. Dec 2010; 19(12): 2095–2109.


Piriformis is a pure abductor at 90 degrees knee flexion-Test resisted abduction
Piriformis at 60 degrees is external rotator - test resisted external rotation.



Dr Ken Nakamura

65 Responses to Piriformis Syndrome: The Best 6 Exercises To Help Your Hip & Butt Pain
  • Sarah says:
    August 27, 2017 at 2:59 pm

    Hi there Dr Ken

    My son 24 has a pain in his butt cheek that is so painful it causes him to faint as he can’t walk.Day to day he is fine then it just comes on at night maybe once a week. He has to take a painkiller sleep and then he is fine again for a week…
    Do you think this could be this piriformis syndrome as the physio he is seeing just gives him stretches that make it worse?

    • Dr Ken Nakamura says:
      September 5, 2017 at 7:47 am

      Thanks for you question Sarah. First, the physio should figure out if the exercises are making him worse by the second visit. I can’t tell you if it’s piriformis syndrome as I don’t know what exercises make him worse and what activities make him worse etc…Let me know and I can give you an opinion.

  • Umesh says:
    August 5, 2017 at 10:57 pm

    Sir. I am Umesh from India. Sir I get some sort of irritation and pain when I walk in my balcony which requires changing direction every 10 steeps. Is is pirimosis syndrome? Which is the best position to sleep with pirimosis syndrome?

    • Dr Ken Nakamura says:
      August 10, 2017 at 6:53 pm

      Thanks for your question Umesh. Everything from a knee problem, hip, lower back problem to local muscles above or below the piriformis can cause your pain. Be specific and write about your what makes things worse eg. sitting, standing, walking, etc….

      I cannot give you an opinion otherwise.

  • JoeD says:
    January 20, 2017 at 2:02 am

    Fantastic report Dr. Nakamura. Some of the best info and easiest to comprehend. I had disc surgery, discectomy, 3 years ago. I spent 2 1/2 years in agony prior to the surgery. It was life changing. I had a herniated disc and a fragment, if I remember correctly. The surgeon told me it was the easiest of discectomies since the fragment was obvious and easily removed. Had 3 years of great health, minus the typical arthritic pain of an active 60 y.o. male. 2 months ago I spent 2 week in a 3′ crawl space working on radiant heat in all kinds of awful positions. One day I noticed a bit of sciatic pain return and within an hour it was full blown debilitating sciatica. After a few weeks of hot showers and ice packs I was at least able to function. I was sure I had a disc bulging but oddly I could bend without any lumbar pain. Web research brought me to your site and it was easy for me to realize it was my piriformis. Your descriptions and pictures were of the greatest help. I’ve been doing the recommended stretching for 2 weeks and the pain is almost completely gone, I can still find it if I try hard enough while stretching. Thank you, great work, I will recommend your site with great enthusiasm.

    • Dr Ken Nakamura says:
      January 20, 2017 at 3:21 am

      You are welcome Joe. Glad your piriformis syndrome is gone.

      • Rizwan sheikh says:
        November 7, 2017 at 9:37 am

        Sir i am rizwan sheikh from India l have 12 year old son. He has left leg short till1inch what type of exercise he should be do or other treatment for him to get better results which is safe for my child

        • Dr Ken Nakamura says:
          November 7, 2017 at 11:22 am

          Thanks for your question Rizwan. I recommend that you see a professional as there are many reasons for a short leg. The bone can be short for many reasons or the muscles can pull one leg shorter for many reasons such as the pelvic flexion and extension. You need to get the more serious conditions ruled out.

          Also, did the person who looked at the problem and determine this “short leg” have training. If they did they should have ruled out the other problems. They should also know the problem is. Also, it may not even be a problem depending on the size of the son. Most people have a short leg but not to that extent. Also, the measurement can be inaccurate and one leg is only 1/2 inch short which, depending on the height of the child put them within normal limits. Which means there really isn’t a problem.

          Hope that helps your child’s short leg. I will do my absolute best to answer your questions.

  • Amy says:
    January 18, 2017 at 3:58 am

    I’ve been doing stretches (just found your site and you have some that I have not tried – so I will be adding those to my routine tomorrow!) for about 2 weeks and I’m still in quite a bit of pain. I was diagnosed with piriformis by my pcp and offered no solution for the pain (wasn’t after pills – just want this to stop!). The stretches are helping some, I’m trying pilates and walking on the treadmill – which all help somewhat. I can deal without sitting most of the day, but I’m having a horrible time sleeping! I seem to aggravate it every night no matter what I do (pillow between the knees). Do you recommend sleeping in a recliner? How long should I expect to be dealing with this? I know everyone is different and you haven’t examined me – but maybe a ballpark figure so I can have something to work towards. This is really starting to get me down!

  • Dennis says:
    December 28, 2016 at 10:16 am

    Dr. Ken, thank you for your article. Your article confirms what I learned from another article yesterday. I seem to have all the classical signs of piriformis syndrome. I started doing the stretches you recommend yesterday. I had been doing inversions but read on another site they would make PS worse. Is that true?

    Thank you, Dennis

    • Dr Ken Nakamura says:
      December 31, 2016 at 7:44 pm

      Thanks for your question Dennis. If you are talking about an inversion machine it will not make piriformis syndrome any worse. It will have no effect at all. If you get worse or better, you more likely have a disc herniation as inversion will take pressure off the disc. When you stand again there is more pressure on the disc so you will feel pain. Then the pain should get better a little bit. This is an opinion and not a recommendation.

      Hope that helps your piriformis syndrome.

  • Priscilla says:
    December 8, 2016 at 3:11 am

    Can we walk fast or run on the treadmill even with this issue? What are the workouts to stay away from and what’s the best thing to do besides what you posted? Thank you

    • Dr Ken Nakamura says:
      December 14, 2016 at 9:42 am

      Thanks for your questions Priscilla. I wouldn’t run on the treadmill but a fast walk should be fine. Best thing is to do the stretches I posted.

      Hope that helps your piriformis syndrome.

  • Hanady says:
    November 14, 2016 at 6:01 am

    I left heavy wieght in may from earth with bad position and diagnosed as piriforms syndrome
    I know that it needs to be exmained clinically and very well
    While i do lunges i feeel pain under my glutes area or the doen of the gluteas area before the hamstring
    Is it pirformis kr sciatica?
    And is heavy lifting from earth cause pirformis injury

    • Dr Ken Nakamura says:
      November 16, 2016 at 10:10 am

      Thanks for your question Hanady. While lifting from the ground usually doesn’t cause piriformis to be injured. This very unlikely. You need to get yourself another health care practitioner. Perhaps a good chiropractor in your area will help more than the person you are seeing. If you are already seeing a chiropractor another chiropractor would be in order. That’s my opinion anyways. It’s not a recommendation.

      Hope that helps your buttock pain.

  • Jane says:
    April 3, 2016 at 6:50 pm

    Hi! I’m a 29 yr old mum of 2, with a son who is now 5 weeks old. During pregnancy I started to suffer from sciatica pain suddenly in the 8th month. I have a large hernia which has never caused sciatica ( even in my 1st pregnancy) although it already showed that it was pressing on nerves. Doctors straight away diagnosed this as my problem. The pain ( left glute/Left calf /foot-pain and pins and needles) became acute after labor. I did not have the tests you have mentioned carried out. An MRI confirmed the preexisting hernia which was still pressing on the nerve. I have seen a chiropractor and physiotherapy and have taken every nsaid under the sun aswell as steroid injections in the glute to no avail. When carrying out the sitting test you describe I have severe pain in the glute. My pain seems to now be centered in the glute as well as the groin and pelvis and hip area aswell as the tail bone area. I am unable to sit down at all due to the glute and sciatica pain and find more relief walking and moving around. Could this be periformis rather than the disc or a mix of both? Thankyou for your time

    • Dr Ken Nakamura says:
      April 7, 2016 at 9:56 pm

      Thanks for your question Jane. The only real way to find out is if you get your piriformis treated but not the disc and see if you get significantly better. Even with disc herniations when you treat the piriformis the disc herniation gets better but only part way.

      In your case though with all the symptoms all around the groin, the piriformis will not do that. Sounds more like a disc to me. I would have someone treat you for a disc and as part of the treatment they should be treating your piriformis anyways.

      Hope that helps your disc herniation.

  • Tarush Gupta says:
    December 27, 2015 at 6:09 pm

    Hi Ken. Your article is a good read. I have a doubt and I hope you can clarify. I have been a regular yoga student and I can do all yoga stretches including the ones you mentioned. But whenever I get up after sitting or standing or lying down , after 4-5 seconds I get a sharp pain in butts and calf which lasts for 3-4 seconds and then it goes away. I have no pain in back while bending forward. Doctors are confused between disc issue or pisiformis. I had MRI 4 years back and mild herniation was diagnosed but nothing major. Is my symptom common ? I don’t have continuos pain. Only 2-3 second pain after getting up from any static position.

    • Dr Ken Nakamura says:
      January 4, 2016 at 7:11 am

      Thanks for your question Tarush. You wouldn’t have trouble getting up from sitting, standing or lying down with piriformis syndrome but you can with disc herniations. It wouldn’t show up on MRI as even moderate disc herniations as most of the pressure on the disc is decreased when lying down to do an MRI.

      It’s not uncommon to have sharp pain initially when they load their spine.

      Hope that helps your likely disc herniation.

  • Julia says:
    December 9, 2015 at 7:15 pm

    Could you please post a photo of how to do the minor test for piriformas as I’m not sure what you mean by “put your bad leg on the chair and bring to opposite side of chest”.
    I have had lower back pain for years which I’ve never had improvement on evern with many chiropractic/physio visits – 3 years ago I had an MRI and they told me “degeneration between L4 and L5”. Recently, I’ve had a pain in my left buttock and extreme pain when I crouch down (i.e. have to hold onto something to get myself up). I am not overweight but in my mid 40’s.
    I’m wondering if I should suggest this piriformis thing to my Dr as she seems to have no clue what’s up with the pain in the back of my legs.
    Thank you!

    • Dr Ken Nakamura says:
      December 15, 2015 at 10:28 pm

      Thanks for your question Julia. It may be piriformis syndrome but not likely as you have pain in both legs. More likely you have disc herniation that is central and large but it can be a number of different diagnosis. The treatments are different for disc herniations and piriformis syndrome. So if your health practitioners didn’t diagnose it properly then they won’t get you better. Likely they didn’t give you the correct treatment as the diagnosis was not correct.

      Hope that helps your buttock and leg pain.

  • Bev says:
    October 18, 2015 at 9:18 am

    Hi, I have been diagnosis with L) sided piriformis syndrome which has been troubling me off and on for over a year now. It recently flared after a session in the garden, as I play golf this is now causing me some issues. I am now experiencing sciatica into my buttock and hip. I have been doing some of the exercises that you recommend. Is there anything you recommend to assist me playing golf eg heel raise, insoles for over pronation? I have attended a chiropractor on several occasions but I don’t find the spinal manipulation of much help.

    • Dr Ken Nakamura says:
      October 19, 2015 at 6:29 am

      Thanks for your question Bev. First it depends on the type of chiropractor you go to just like which medical doctor you go to. You should try foam rolling the piriformis and glut medius as well as the hamstrings if the sciatica is going down the back of your leg and the side of your leg if the sciatica is going down the side of your leg.

      Hope that helps your possible pifiromis syndrome.

  • Mick Phythian says:
    July 27, 2015 at 10:20 pm

    I’d never come across the piriformis until I started attending a chiropractor for low back pain (I have a worn facet joint) but raised the fact that after I’d been prescribed statins (after a heart infection) I’d been unable to sit down on my left butt-cheek or raise my left arm until a while after I’d stopped taking them, and I’d been stuck with this butt pain in a milder form ever since. I get disturbed in the night due to pain in my left hip when sleeping on that side and this is what my chiro tries to sort by applying pressure. Any thoughts?

    • Dr Ken Nakamura says:
      July 28, 2015 at 8:59 pm

      Thanks for your question Mick. Sorry to hear about your butt-cheek. You can try these exercises or you can try acupuncture for this problem. The other alternative is try getting a practitioner that does ART.

      Hope that helps your butt cheek or rather your piriformis.

  • Sam Hbaruas says:
    July 18, 2015 at 3:08 pm

    Dear Dr. Ken, your website has been a source of great knowledge and comfort for me over the past year – god bless you.
    I have been struggling for the past five years and diagnosis has moved from L4-L5 issues; SIJoint related; Piriformis Syndrome (based on who I saw!) etc. etc.
    However, the needle of suspicion is now around Pudendal Nerve entrapment (all issues started after a traditional cut and chop hemerroidectomy and symptoms that trigger post sitting in the shape of left sitbone and left SIjoint area pain; pain triggering immediately after wearing pants tight around the groin region; leg weakness etc.
    May I request your inputs on what sort of exercises (a) one should do to see if the pudendal nerve relaxes and (b) what sort of exercises not to do if the suspicion is pudendal never related, and (c) other inputs you feel worthy of consideration for me and fellow sufferers.
    I am amazed by how late in the game someone mentioned pudendal nerve cause once I read about it, all my symptoms suddenly started making sense! Your guidance will benefit many and I look forward to hearing from you. Best wishes to you always!

    • Dr Ken Nakamura says:
      July 21, 2015 at 9:41 pm

      Thanks for your question Sam. I am sorry but I have no experience with Pudendal Nerve Entrapment. This is out of my scope of practice. You will have to find someone who can treat you properly. I am sure you have already been treated at the origin of the sacral nerves with ART at the greater sciatic notch.

      If it was piriformis syndrome I could better give you advice.

      Hope you find someone with exerience in this area.

  • Lucy says:
    May 17, 2015 at 5:20 am

    Dr. Ken, after reading your article, it makes a lot of sense because I was diagnosed with bulging discs on my spine and then my piriformis muscles got very tight. This has been ongoing for years now but since last year, it got worse. Now I cannot walk or stand for a long period of time, or if I sit for a long time, getting up to walk can be painful to my hips also. Sometimes if I walk a lot, my legs would even get numb. I also had polio when I was 1 year old, and it affected my left thigh muscle, so I rely my right side for the strength, thus the piriformis syndrome is now affecting my right side. My question is, is the piriformis syndrome reversible? I’ve been doing all kinds of stretching, including the ones you’ve shown in your article, for months and I do it morning and night, but still the muscle is still very tight, seems like the exercises have no effect to make me better or stronger. Is that because of my bulging discs and that’s why my piriformis syndrome will not go away? I hope you can respond. Thank you in advance.

    • Dr Ken Nakamura says:
      May 19, 2015 at 9:24 am

      Thanks for your question Lucy. You should try these exercises https://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/

      Sounds like the disc is affecting you more than the piriformis muscle. If the exercises give you more pain you should stop the exercises especially if the exercises give you more symptoms further down the leg the numbness, tingling, or pain.

      Hope that helps your disc herniation.

      • Lucy says:
        May 24, 2015 at 9:35 am

        Thank you Dr. Ken for taking the time to answer my question. I have also done the Sphinx pose and that seems to irritate my piriformis muscle also. I will try the other exercises and see if that will help or not. I have one other question, since I’ve had Epidural Steroid injections twice before, and it provides a lot of relief. However, each time only lasts about 3 weeks at most. Is there other forms of injections that can have longer term results? I’ve heard that sometimes people use Botox to be injected in the piriformis muscles, have you heard of that and will that have better result? It is so frustrating that the pain on my right butt just doesn’t want to go away and it feels like pulling all the time that it creates the tightness and the pain.

        • Dr Ken Nakamura says:
          May 24, 2015 at 8:55 pm

          Thanks for your question. No I haven’t heard of any patients getting botox for their piriformis muscle but I have for the neck with success for 6 months. I would still stick with the other exercises I have given you for disc herniations. In your case they should be supervised as you have a complication with the previous polio which would have affected the muscles, posture and balance and thus contributing to your apparent disc problem.

          Hope that helps your disc problem.

  • Rosalind says:
    April 20, 2015 at 12:40 pm

    This is the first time I have really delved into figuring out where this pain is coming from and how to help myself. I have had injections into my back to help with my bulging disc a couple of times in the past and that seems to relieve the pain I have in my right butt cheek so I have always just felt like that is where the pain is coming from. Now on further info gathering I’m feeling like the pains I am having seem to be the pisiform is. If I follow through with your stretches when do you think I should see some results? Thank you for your time.


    • Dr Ken Nakamura says:
      April 21, 2015 at 9:13 pm

      Thanks for your question. Without examining you I can’t tell you for sure if it is piriformis or disc herniation or degenerative disc disease DDD. Try the exercises for two weeks. If they get worse stop but if you get better continue on.

      Hope that helps your possible piriformis syndrome.

  • Dr Ken Nakamura says:
    March 30, 2015 at 3:47 am

    Thanks for your question Tom. The problem is likely a disc but that is an educated disc. https://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/

    Try these exercises. However if the exercises increase the pain or make any symptoms like tingling numbness, or pain go further down the leg then you should stop.

    Hope that helps your possible disc herniation. (This is simply eduational advice – not a diagnosis)

  • Tom says:
    March 28, 2015 at 5:47 am

    Hi Ken the promble seems to be getting worse, now if I rub along the spine and both bum cheeks it’s sets the styptoms off down my leg! You’re right though my doctor seems to think stress. I’m woundering if a disc problem could cause these styptoms when pressing the muscles around spine and bum cheeks. Or could it be psychosomatic?

  • Tom says:
    March 7, 2015 at 6:44 pm

    Thanks for help! I’ll carry on stretching.

  • Tom says:
    March 6, 2015 at 4:41 pm

    I have a very tight left pirifomis muscle, but I get leg pain in right leg? If I rub my left pirformis the symptoms increase in my right leg? Do these symptoms sounds normal for piriformis sydrome can a tigh left piriformis cause the right to put pressure on sciatica nerve or is this something else? Any help is kindly appreciated.

    • Dr Ken Nakamura says:
      March 7, 2015 at 11:27 am

      Thanks for your question Tom. Very interesting. Patients sometimes tell me if I push on one side of the neck that the other side of neck or the arm on the opposite hurts. This goes for the piriformis, low back muscles. It’s not that common but it happens more than you would think. My thinking is that since your piriformis muscle that you are pushing on is attached to the sacrum. It tightens the muscle while pushing causing a slight shift in the sacrum. An already irritated sciatic nerve on the opposite side (right) will cause pain in the leg on the right. That’s a educated guess though.

      There are so many things science doesn’t understand. On the other hand I think most health professionals that are not hands-on will think that you have some psychosomatic issues.

      Hope that helps your possible piriformis syndrome.

  • Lionel says:
    February 20, 2015 at 9:34 pm

    Hi Dr. Nakamura.

    I’m a 42 year old father of 2 small kids who had played a lot of sports and still plays once a week. Three years ago I was told I had 2 herniated discs (L4/L5 & L5/S1). About a week ago the pain struck again after a few months building towards it and I have not been able to walk properly for over a week. The pain is mostly located on my left side in my glute and runs down below my knee and above the outside of my ankle. I’ve tried your tests and I’m not sure I have piriformis syndrome. I am able to sit and lay down but standing and walking puts tremendous strain on my back (I can feel all the muscles contract/tense up). When I walk I am unable to extend my left leg and can feel my hip twist in order to bring that leg forward (picture a zombie walking). I’ve tried the prone position in bed but the pain in those 3 areas on my left side are intense & I can only hold the position for about 5-10 seconds. Thoughts?

  • Tim Hodgson says:
    November 25, 2014 at 4:44 am

    Dear Dr Ken,

    I’m researching my current injury. Have come across your site, which I find very informative and helpful. Aged now 40, I have over exerted my back working with stone, originally an incorrect straight legged lift of friend who jumped on my back in late teens slipped L3. I have managed as best as real life allows my back and have had massage and chiropractic work.

    Currently I have protruding bulges from MRI scan of L5 S1 & L3 at the same time.

    Interested in your views on a few things – personally feel piriformis issue is there and will follow the above – what are your views on inversion therapy as an aid to recovering? I have viewed many opinions but have an empathy that you real feel for the issues.

    • Dr Ken Nakamura says:
      November 25, 2014 at 9:58 pm

      Thanks for your question Tim. Inversion tables are helpful for disc herniations and stenosis. If the inversion table helps you don’t have piriformis syndrome. When you have a disc herniation or disc bulges the piriformis exercises will help though as the sciatic nerve and innervates or goes to the piriformis muscles. In other words disc herniations affect the piriformis muscles.

      From your comment, if you sit for a while and having trouble straightening up or having trouble when you cough or sneeze, or are bent over side ways you likely have a disc herniation rather than piriformis syndrome.

      Hope that helps your pirifomris syndrome or disc herniation.

      • Tim Hodgson says:
        November 26, 2014 at 5:32 am

        Appreciate you time and consideration – I have a long 4-6 months ahead to readjust a number of practices in my life but will be sticking by your site throughout. Warm (and iced!) Regards Tim

  • Bella says:
    November 14, 2014 at 7:04 am

    Hi Dr Ken this is most probably a silly question but have read that when the piriformis is tight it can turn your foot out when standing which is what happens to mine, but when I sit in my recliner with my legs up my kneen truns in and so does my foot, I know when the leg is brought up the piriformis changes roles in the job it does so was wandering with the leg brought up in this position if it’s tight would it turn the foot in? I have Most probably got it all wrong but thanks!

    • Dr Ken Nakamura says:
      November 14, 2014 at 8:14 am

      Thanks for your question Bella. Yes while you are standing the piriformis muscle turns the leg out while the muscle turns into a hip abductor when you sit. Hip abduction is bringing your leg out sideways.

      The gluteus medius and minimus turns your hip in, while the foot flexors like the flexor digitorum longus, flexor hallucis longus tibialis posterior help turn the foot in. However it could be the way you are sitting.

      Hope that helps with your understanding of your piriformis while sitting and standing.

      • Bella says:
        November 16, 2014 at 4:34 am

        Thanks a lot Dr Ken for explaining how it works!

  • Bella says:
    October 26, 2014 at 2:42 am

    Hi Dr Ken
    Would erratic nerve pain in one leg be the styptom of piriformis sydrome. Have ache in front of thigh, sharp pain in back and outside of thigh also, plus sharp traveling pain in front shin and stabbing pain in outside of calf. I don’t experienced the pains all at one time but throughout the day, with some days no pain at all. Mri and scans on spine come back showing no problem. I know it’s difficult to say without seeing me in person but does this sound like piriformis sydrome? Thanks

    • Dr Ken Nakamura says:
      October 26, 2014 at 11:45 am

      Thanks for your question Bella. You are basically saying that since you don’t have a disc herniation or any other visible problem on MRI scans do I actually have piriformis syndrome. Fair enough question. In your case I can’t tell what your pain is without an examination. It also doesn’t sound like piriformis syndrome. I recommend a second opinion.

      Hope your get some good help for your thigh and leg pain.

  • robert says:
    October 18, 2014 at 5:26 pm

    Thanks so much for your informative web site! I’m a 50 yr old male. I do squats regularly, bodyweight and with weights, some lunges. I have one leg longer than the other, more than an inch. On the short side, I have some minor pain in the butt, right where the piriformis is located. It feels like there is a knot. In the mornings, especially if I slept on my back instead of on my side, I am stiff and sore and find it hard to lean forward or to bend down. The soreness occurs when I squat deep and only on my short leg side. It mostly goes away by the end of the day. Self myofascial release (SMR) with a tennis ball causes some pain in the piriformis area and seems to help release but I keep feeling the knot. Walking and swimming seems to help. Should I do more stretches, more SMR? Nerve flossing? Can I get back to squatting and lunging with intensity? Should I have an MRI? Thank you!
    Any other suggestions?

    • Dr Ken Nakamura says:
      October 19, 2014 at 3:50 am

      Thanks for your question Robert. Sounds like you are taking care of the symptoms and not the cause. First you need to take care of the short leg. (Assumming that the diagnosis of a short leg is correct – Many people have a functional short leg and not a actual short leg ) eg. Chiropractic adjustments help an apparent short leg by evening out the motion in the pelvis. Whereas if the leg were actually short chiropractic adjustments would have no effect.

      If the diagnosis is correct, (I can’t determine that without examination) I would add a heel lift to the short leg side. I would try adding 3mm or 1/8 inch at first. Why would you not add one inch? Your body has already compensated best it can so if you add one inch it will cause more problems than you have now. Then I would go to 2/8 inch or 5-6mm. I would probably stop here for the heel lift.

      The other thing is that you likely have a bulging disc due to the uneven pressures from the short leg. However I would even you out with the heel lift to your body’s tolerance first than work on the disc herniation exercises here. https://www.bodiempowerment.com/herniated-disc-part-2-the-best-exercises-for-your-herniated-disc/

      You should get a professional that knows what they are talking about. You can treat yourself but you run the risk of overcorrecting or even causing more problems.

      I am only giving you this information so you can ask the right questions. If they don’t know what you are talking about go to the next professional.

      Hope that helps your piriformis muscle.

  • Ayzha says:
    October 10, 2014 at 7:18 pm

    Thank you so much for sharing this!! I have been working with now THREE doctors here in Toronto to figure out this pain! Although I am no doctor, I feel this is what has been going on with my body!

    I fell at work on July 27th (a slip on a wet surface) and landed on both knees. The day after I started experiencing sharp muscle spasms in my right buttox that I could barely feel in my thigh. Now, almost 3 months later , the pain continues to get worse with pain down into my thigh…knee area … calf and the odd time my ankle area.
    The pain does feel better after physiotherapy or massage therapy and stretching. My physiotherapist mentioned that my hip rotation on my left side is completely normal but I don’t have much movement on the right side.
    Could the fall at work possibly injured the piriformis muscle?

    I just want to feel better and have some peace of mind.

  • Bella says:
    October 5, 2014 at 4:41 pm

    Thankyou! 🙂

  • Bella says:
    October 5, 2014 at 6:23 am

    Hi is it only a tight piriformis that can cause pain? Can a weak one also cause pain?

    • Dr Ken Nakamura says:
      October 5, 2014 at 10:55 am

      Thanks for your question Bella. A weak muscle can be tight to try and compensate so yes, it can cause pain locally and even sciatica in some cases.

      I would do the exercises I have presented in in this article.

      Hope that helps your weak piriformis.

  • Milovan Markovic says:
    September 26, 2014 at 3:13 am

    Hi Ken.I have a problem with the spine.I have shoot in spine and thats complicated situation with my knee and last lodge because my knee is sometimes shoot also and i have a shot in hurdles and that s irritating my neck also shoot and sometimes i have a pain in my head so if you could help me with some excecises i ll be grateful. P.S.Sorry if my English is bad

    • Dr Ken Nakamura says:
      September 27, 2014 at 9:56 am

      Thanks for your question Milovan. Sounds like you have shooting pain in your spine and also knees when your do hurdles. It also bothers your neck and head. Any exercises I prescribe may hurt you as I haven’t examined you and determined the cause of such as complex problem. I recommend you see someone in person to help you.

      Hope you get help.

  • Helen Agnes Tavares says:
    September 10, 2014 at 5:17 pm

    Hello again Ken,

    What I marvel is the simplicity of these exercises and the positive results they produce. Excellent!

    Always good reading and beneficial. Thank you once again!

    • Dr Ken Nakamura says:
      September 10, 2014 at 6:05 pm

      Thanks for your Comment. Glad your piriformis syndrome is feeling better.

  • Oystein says:
    August 23, 2014 at 2:19 pm

    What your write makes a lot of sense and corresponds with my own experience. I think I have a combination of Piriformis Syndrome that has developed into an early phase Slipped Disk and wonder how to deal with it. My pelvis is out of balance since I put all my weight on one foot due to the pain on the other side. My chiropractor have proscribed painkillers and rest combined with regular chiropractor treatments every other day where we do light stretching in a stretch bench to relieve the pain and stabilize the disc first and after that to work on breaking up the pelvis and the piriformis. I goes with the story that i had two slipped disks 25 years ago, a thorn hamstring 4 years ago and that I fell and had a traumatic hit to the hip 2 years ago. I believe that it is the hit to the hip bone that have caused the imbalance in the muscles in the butt and the hip and that eventually has made an imbalance that has caused the disc problem. I am a little in doubt with regards to the chiropractor. I do not feel the light stretch bench stuff does much good, but it costs a lot of money. So my question is, should I go on with the chiropractor stretching or should I rather do your exercieses and if so, should I start with the exercises for the disc and then later go on to the piriformis exercises? Your advice will be much appreciated.
    Best regards

    • Dr Ken Nakamura says:
      September 2, 2014 at 11:20 am

      Thanks for your question Oystein. You are the first Norwegian to ask a question. A good way to find out if the stretch bench is to do a check right before and right after the stretch bench. For example if you can bend forward 30 degrees before the stretch and 40 degrees after the stretch then it is working. See if it is a durable or longer lasting response. If it is stick with it. If not than try the disc exercises first. You would try the disc exercises first as you can never get disc problem that is causing a piriformis problem with the piriformis exericses. Also the disc exercises will help some piriformis syndromes. Than do the piriformis exercises.

      Hope that helps your piriformis syndrome.

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